EVALUATION OF INTRAOPERATIVE SELECTIVE LEFT GASTRIC VEIN INJECTION SCELROTHERAPY WITH SPLENECTOMY AND DEVASCULARIZATION IN PATIENTS WITH PORTAL HYPERTENSION

Abstract

The problem of liver cirrhosis with development of portal hypertension and esophageal varices becomes a major problem in Egypt and its management carries a major debates.

To face this problem we tried to study the esophagus from the anatomical part of view and we found the most important part is the lower 6 em of the esophagus with its intramural and extramural veins. The detailed assessment of the patient who has this problem is very important whether clinical evaluation, biochemical evaluation, ultrasonography, and upper GIT endoscopy. The various treatment modalities was discussed as medical therapy, transjugular intrahepatic portosystemic shunt (TIPS) and surgical options whether it is shunt, or non shunt procedures. The shunt procedures include non selective shunts as portocaval, mesocaval, proximal splenorenal shunt. Selective shunts as distal splenorenal shunt and coronocaval shunt, and non shunt procedures as splenectomy and devascularization, and esophageal transection. We discuss the different results according to the other's studies and we tried to expose our new idea to combined splenectomy and devascularization with intraoperative injection sclerotherapy through the left gastric vein and we discuss our results in relation to the previous ' studies, and we found it primarily satisfactory.